For a successful transition to PDGM, HHAs must develop a thorough understanding of how PDGM changes will affect reimbursement and clinical operations. Agencies should take the following actions to begin preparation for PDGM:
1. Ensure that who ever is finalizing your agency’s ICD-10-CM coding fully understands that the primary diagnosis needs to be specific enough to meet the code list requirements that group patients into Clinical Groupings & the significance of coding all comorbidities/secondary diagnoses that are pertinent to the patient’s care plan and will impact patient care and the Comorbidity adjustment when calculating a case-mix grouping for PDGM.
2. Evaluate your current practice of providing therapy services. Determine how to provide therapy effectively for patient care and outcomes while containing costs. Consider utilizing therapy assistants, telehealth/remote monitoring, etc.
3. Evaluate your HHA’s current revenue cycle process. This will allow you to establish whether or not the agency will need to add staff or outsource billing to manage the increased billing volume.
4. Review Calculations of the impact of the PDGM model on the agency’s reimbursement overall.
5. Review Calculations of the cash flow impact for the first months of 2020 to establish if your agency will need to consider building cash reserves prior to the implementation of PDGM.
6. Review the agency’s Clinical Operations. Establish patient care plans, determine the frequency and duration of visits, and decide how to best reinforce the expectations of continued excellent patient care and outcomes under PDGM.
7. Evaluate the current level of LUPA episodes and how that will vary under PDGM.